EP248: United We Could Definitely Stand Against Rising Health Care Costs, With Mark Blum From America's Agenda
Episode Description
In this episode, Stacey Richter talks with Mark Blum, executive director of America's Agenda, about how uniting labor and employers could stand against rising health care costs.
WHAT YOU'LL LEARN
✅ Why deductibles are rising at eight times the rate of inflation
✅ How America's Agenda used a "reverse auction" to save New Jersey unions $1.6 billion on pharmacy benefits
✅ How to design a purchaser contract that eliminates hidden pricing in PBM contracting
✅ Why PBMs resist these kinds of reforms
✅ How labor-owned direct primary care can improve outcomes while reducing costs
WHY THIS MATTERS
Mark Blum makes the case that instead of employers and unions fighting each other over cost shifting at the bargaining table, they should unite against the actual drivers of rising health care costs—excess middleman profit, private equity extraction, and a system that rewards volume over value. His concrete example, a reverse-auction PBM contract that saved New Jersey unions $1.6 billion over three years, shows what's possible when purchasers negotiate collectively and demand transparent terms.
MENTIONED IN THIS EPISODE
=== LINKS ===
🔗 Show Notes with all mentioned links: Episode Page
🔗 Healthcare Industry Acronyms and Terms
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00:00 Introduction.
03:17 Employers and unions—combining forces.
04:04 Rising deductibles at eight times the rate of inflation.
04:40 Creating and sharing savings, rather than fighting over cost shifting.
05:45 Working with New Jersey unions to have meaningful reduction in pharmacy benefits manager (PBM) spend—New Jersey Education Association (NJEA); Communications Workers of America (CWA); American Federation of State, County and Municipal Employees (AFSCME); Patrolmen's Benevolent Association (PBA); among others.
07:57 Finding the next PBM to serve all these people in New Jersey using a "reverse auction."
09:04 Designing a purchaser contract to eliminate hidden pricing in PBM contracting.
16:20 "There is no reason other PBMs couldn't participate in reverse auctions like this."
16:35 How reverse auctions like America's Agenda's auction in New Jersey are possible in virtually every state.
17:58 "The big obstacle to doing this … is that the PBM industry is remarkably profitable."
19:25 Tactics among PBMs—Vinay Patel discusses in EP241.
20:26 Why PBMs don't want to see this change.
21:51 "What stops them from reducing reimbursements to community pharmacies?"
22:05 "Best-in-class terms can build in requirements that PBMs may not spread price."
24:37 America's Agenda's transformation of direct primary care.
26:56 America's Agenda's biggest innovation in labor direct ownership of direct primary care.
28:24 Aligning the interests of patients and physicians.
29:46 The big crisis in American health care—rising costs.
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